Impact of a Multi-Component Home-Based Physical Therapy Intervention on Cognitive Outcomes: Results From the CAP Randomized Controlled Trial

Objective: Differences in cognitive outcomes for two home-based 16-week interventions after usual rehabilitative care post-hip fracture were examined. Methods: Community Ambulation Project randomized controlled trial included 210 hip fracture participants. Interventions: Specific multi-component (PUSH) included strength-, balance-, function-, and endurance-based exercises; non-specific active control (PULSE) included seated range-of-motion exercises and sensory transcutaneous electrical neurostimulation. Cognitive measures: Modified Mini-Mental State Examination, plus Hooper Visual Organization Test and Trails A/B in an ancillary study (CAP-MP, n = 40), assessed pre-randomization and 16 and 40 weeks post-randomization. Results: Over 16 weeks, PUSH-assigned participants became faster on Trails A (Δ = −6.3, 95% CI: −16.7, 4.2); those in PULSE became slower (Δ = 9.3, 95% CI: −1.7, 20.3, p =.04). At 40 weeks, PUSH-assigned participants became faster on Trails B (Δ = −21.5, 95% CI: −46.2, 3.3) while those in PULSE became slower (Δ = 15.2, 95% CI: −11.9, 42.3, p =.04). No other significant differences were found. Discussion: Results suggest that multi-component exercise interventions like PUSH may prevent/delay decline or improve attention and psychomotor speed in patients with recent hip fracture.